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Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review

Jonathan A Drezner1, Aneil Malhotra2, Jordan M Prutkin3

  • 1Center for Sports Cardiology, University of Washington, Seattle, Washington, USA jdrezner@uw.edu.

British Journal of Sports Medicine
|January 21, 2021
PubMed

Insights

Hypertrophic cardiomyopathy (HCM) in young athletes poses risks for sudden cardiac death (SCD). While disqualification was standard, current evidence supports shared decision-making for safe sports participation with HCM.

Area of Science:

  • Cardiology
  • Sports Medicine
  • Genetics

Background:

  • Hypertrophic cardiomyopathy (HCM) diagnosis in young athletes creates dilemmas for safety, autonomy, and risk tolerance.
  • Previous recommendations advised blanket disqualification from sports for athletes with HCM.
  • Recent studies and cohort reports question the necessity of complete sports exclusion for HCM patients.

Purpose of the Study:

  • To critically review evidence regarding sports eligibility for young athletes diagnosed with HCM.
  • To examine the risks and benefits of sports disqualification in this population.
  • To explore challenges in shared decision-making for athletes with HCM.

Main Methods:

  • Literature review of epidemiological studies and cohort reports on HCM and sudden cardiac death (SCD) in athletes.
  • Analysis of histopathological substrate of HCM in relation to exercise.
  • Examination of risk factors for SCD in young athletes with HCM.

Main Results:

  • HCM creates an unstable myocardial substrate, increasing ventricular arrhythmia risk during exercise.
  • Young age and intense competitive sports are identified risk factors for SCD in HCM patients.
  • Adolescent/young adult males and athletes in high-risk sports (basketball, soccer, American football) face greater risk.

Conclusions:

  • Shared decision-making is increasingly endorsed in sports cardiology for HCM athletes.
  • Evidence suggests a nuanced approach beyond blanket disqualification is warranted.
  • Challenges remain in shared decision-making when consensus is not reached among all parties.

Keywords:
cardiovasculardeathheart diseasepreventionsport

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